HomeMy WebLinkAboutProject Completion Affidavit - Douglas Landscape Inc - 2016 Tree Planting Project No 116-031T ,
-�t�,7777
fi = I
■l
a�
a
, t«
� .. ALM,��
2
WEB'T BEND
A MUTUAL INSURANCE CQM?ANYv
Bond Number 2368969
Maintenance Bond
That Douglas Landscape, Inc of 23590 Ardmore Trl, South Bend, IN 46628-5102 as Principal, hereinafter called
Principal, and WEST BEND MUTUAL INSURANCE COMPANY of Wisconsin, with its principal office in the City of Middleton,
Wisconsin, and duly authorized and licensed to do business in the State of IN as Surety, hereinafter
called Surety, are held and firmly bound unto City of South Bend Board of Public Works as Obligee,
hereinafter called Owner, for the use and benefit of claimants as hereinafter provided in the amount of
Eleven Thousand Two Hundred Seventy Nine Dollars Dollars ($ 11,279.00 }
for the payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and
assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal and Obligee entered into a written contract on the 8th day of September , 20 17
for the 2016 Tree Planting. Project No. 116-031
all in accordance with the plans and specifications prepared by
NA and
WHEREAS, said contract provides that the Principal will furnish a bond to guarantee, for the period of 2 year(s)
after approval of the final estimate on said job, by the owner, against all defects in workmanship which may become ap-
parent during said period, and
WHEREAS, the said contract has been completed and was approved on September
8th , 20 17
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that, if the Principal shall indemnify the Obligee
for all loss that the Obligee may sustain by reason of any defective workmanship which becomes apparent during the
period of 2 year(s) from and after September 8th 20 17 then this obligation shall
be null and void; otherwise it shall remain in full force and effect.
Signed and Sew tl s 8A day of �, ember 20 17
Principal:
Douglas Landscape, Inc
By:__ --fir & '�`_ (n�SC:AL)
Name Typed: lwlx,t. Af. k, /;"/ //01� "-/�/G'�/�&I/
Title
Surety: ,
We n �tual.lnsurande Company
By: �_+ _ "_ (SEAL)
Name Typed: PATRICCK KENNEDY Attorney -In -Fact
Title
MI C} (GAN ONLY s policy is "6mpt from the filing re ements of Section 2236 of the Insurance Code of 1956, 1956
PA 218 a_Dd'MCL 500.223(
NB 0014 02 08 Page 1 of 1
8401 Greenway Blvd. Suite 1100 1 Middleton, WI 53562 1 Phone: (608) 410-3410 1 Fax: (877) 674-2663 1 www.thesiivertining.com
WEST BEND
A MUTUAL INSURANCE COMPANY'
2368969
Power of Attorney
Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in
the City of West Bend, Wisconsin does make, constitute and appoint:
PATRICK KENNEDY
lawful Attorneys) -in -fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any
and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship
executed under this authority shall exceed in amount the sum of: Seven Million Five Hundred Thousand Dollars ($7,500,000)
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following
Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held
on the 21 st day of December, 1999.
Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance
Company may appoint by written certificate Attorneys -in -Fact to act on behalf of the company in the execution of and
attesting of bonds and undertakings and other written obligatory instruments oflike nature. The signature of any officer
authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate
relating therefore and any such power of attorney or certificate bearing such facsimite signatures or facsimile seal shall
be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and
facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other
writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause,
by any said officer at any time.
In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president
undersigned and its corporate al to be hereto duly attested by its secretary this 1 st day. fyarch, 2009.
AttestJ��
' •. .
Ja a J. Pa oftPorzgr �"'
i:�c E:.o':: Kevin A. Steiner
Se tart' :�:� SEAL y> b Chief Executive Officer/ President
State of Wisconsin T `' erotic°'` Y.
County of Washington
On the 1 st day of March, 2009 before me personally came Kevin A. Steiner, to me known being by duly sworn, did
depose and say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend
Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the
seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order
of the board of directors of said corporation and that he signed,.his name thereto by like order.
* NOTARY John F: D well
PUBLIC Executive Vice President - Chief Legal Officer
NotaryPublic Washington Co. WI
.............. O: e
:OF WtiSC''' My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a
Wisconsin corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of
Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth
in the Power of Attorney is now in force.
Signed and sealed at West Bend, Wisconsin this 8 day of September 2017
SEAT. DaleJ. Kent
Executive Vice President -
Chief Financial Officer
NOTICE: Any questions concerning this Power of Attorney may be directed to the Bond Manager at NSI, a division of West Bend Mutual I nsurance Company
8401 Greenway Blvd. Suite 1100 1 P.O. Box 620976 1 Middleton, W1 53562 1 ph (609) 410-3410 1 www.thesilverlining.com
Final Waiver of Lien
State of Indiana, CountySS,
�of �0 S
.DO l�l mo. n being duly sworn that he/she is the r 5
en
(blame of Officer) I (Title)
Of -DOM (a-S La-^d1; havingcontractedwith e. —80-F 7
(Contractor) (Owner)
to fhmhh certain materials andlor labor as follows:
for a project known as
located at
and owned by
and does hereby further state on the behalf of the aforementioned subcontractor/supplier:
(PARTIAL WAIVER) that there is due from the Contractor the sum of
Dollars ($ - )
❑ receipt of which is hereby acYnaowlodged; or
the payment of which has boon promised as the sole consideration; for this Affidavit and final Waiver of Lien-whloh is given
solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the
undersigned;
(FINAL WAIVER) that the dal balance due Rminx the contractor Is the start of
❑ receipt ofwhieh is hereby aclmowledged; or
❑ the payment of which has been promised as the Sole consideration for this Affldavlt and Final Waiver of Lien which shall
become effective only uponreceipt of such payment.
TFIBREFORE. the undersigned waives and releases unto the Owner of said promises, any and all liens or claims whatsoever
on tho above-deserlbed property and improvements thereon an accouc,t of labor ormiltarial or both, furnished b the undersigned
thereto, subject to limitations or conditions expressed herela, if any; and further certified that no other party has any claim or right to a
lion on account of any workperfonned or material famished to the undersigned for said project and within the scope oftbis Affidavit
and WaiverofLien.
(Firm) (Authorized Repres tutive)
STATE OF MIANA )
SS;
ST. YOSSPH COUNTY )
Before me, the undersigned, a Notary Public, In and for sold County and State, personally appeared Wit, tirn/� n
and aekltowledged the execution of the foregoing Affidavit and Waiver of Lien.
IN WITNESS W03REOF, I have hereunto subscribed my name and affixed my official seal on the a?M h day of
SU 1W 2091
Noey Publff Signature k�
MyCommission Expires: ao_ !
R$slding in 5-� . �p 5� County, �� �,�, n � -f� L . � GI'� wifi Z,
1ENNIFER L SCHULTZ
.NOT::iiY PUBLIC - OFFICIAL SEAL
Slato of Indiana, St. Joseph County
My COMM, Expires September 27, 2019
I
0